U.S. Global AIDS Ambassador, Eric Goosby (left) speaks with a colleague at a breifing on combination prevention for HIV on the Hill Wednesday.

U.S. Global AIDS Ambassador Eric Goosby joined other HIV physician-scientists on Capitol Hill Wednesday to discuss the various evidence-based approaches to prevent HIV infection that the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program is implementing on the ground in the countries hardest hit by the AIDS pandemic. The briefing was the first in a series that will be hosted by the Office of the Global AIDS Coordinator in the months leading up to the International AIDS Conference in Washington, DC in July.

Committing to end the pandemic – as outlined by the president in a speech on World AIDS Day and a seperate speech by Secretary of State Hillary Clinton in November at the Natinoal Institutes of Health – will require reliance on science-based policy, and a comprehensive approach, said Chris Collins of the Foundation for AIDS Research (amfAR), which co-hosted the event along with PEPFAR and the Center for Global Health Policy.

And given the economic climate, it will also require doing more with less.

Dr. Goosby outlined PEPFAR’s latest effortsin that regard, including driving down the per-patient, per-year cost of antiretroviral therapy (ART) from $1100 when the program first started in 2004 to $335 in 2011, vowing they will continue to do even better. Improvements in supply chain management, and shipping drugs via land instead of air, are some of the ways these cost savings were garnered.

“I can say with confidence that the progress over the next year will be dramatic,” Goosby said.

A slide from presenter Chris Beyrer, MD, showing the decline in HIV incidence in all African countries supported by PEPFAR except Uganda.

He also highlighted progress during the World Economic Meeting in Davos last week, where PEPFAR joined forces with business leaders in a new effort to eliminate new childhood infections by 2015. Business leaders will support ministries of health and local entities to meet this goal, and a social media syndicate will also use the most “influential, influential, individual publishers on the Social Web to share messages and actions needed to welcome a ‘Generation Born HIV Free’ and to achieve all the health-related Millennium Development Goals,” according to a press release. In 2010, 390,000 children were newly infected with HIV.

PEPFAR worked to avert 200,000 pediatric HIV infections last year, mainly through prevention of mother-to-child transmission (PMTCT) programs, “And we know we can do much more,” Goosby said.

PEPFAR also helped support 1 million voluntary medical male circumcisions (MC) in 14 countries in sub-Saharan Africa with high HIV incidence, low rates of MC and a predominantly heterosexual epidemic. Three randomized controlled trials demonstrated that circumcised men were more than 60 percent less likely to acquire HIV during vaginal sex than those who were uncircumcised. Subsequent trials have shown that the benefit of the one-time, safe, and relatively inexpensive intervention lasts over time. Goosby stressed President Obama’s goal of supporting more than 4.7 million MC over the next two years.

There could be a number of reasons for this unnoticed decline of HIV incidence in Uganda. Uganda’s HIV prevalence has stagnated for a number of years meaning that the incidence is balanced off by other factors like, say, population growth. Secondly, the stagnation of prevalence is that the prevention effort is only equal to the incidence problem, it is not rising neither is it falling. Thirdly, the prevention efforts could have been overwhelmed by care and treatment in terms of resources. Fourth, the prevention effort through the ABC strategy which saw Uganda’s significant success has not received good acceptance and support like it did in the 90s and, perhaps, earlier. Yes, we need to continually take stock of what is happening; what is working and what is not working. Regards.